Many eye doctors prefer low-dose (0.01%) instead of high-dose (0.5% or 1%) atropine for myopia control because of its lower risk of side effects. However, a recent abstract published as part of ARVO’s 2020 online meeting explored the one-year effectiveness of high- vs. low-dose atropine in myopic patients, and its results were actually more in favor of the high-dose (0.5%) regimen.

The study included children between the ages of six and 13 with bilateral progressive myopia and a spherical equivalent refraction of -0.5D to -6.0D, 128 of whom received 0.5% atropine treatment and 37 received the 0.01% formulation. At baseline, median refraction was -4.19D for 0.5% atropine and -3.75D for 0.01% atropine. Median axial length baseline measurements were 24.66mm and 24.59mm, respectively.

At six months, median refraction and axial length progression were +0.19D and 0.00mm, respectively, for 0.5% atropine, and -0.03D and 0.15mm for 0.01%. At one year, median refraction and axial length progression were +0.12D and 0.07mm, respectively, for the high-dose group and -0.25D and 0.19mm for the low-dose group. At six months, 7% of children who were on 0.5% atropine and 5% of children who were on 0.01% atropine stopped therapy.

While dropout rates were somewhat higher with high-dose therapy, the researchers noted that the vast majority of the group managed to adhere to therapy. They concluded that high-dose atropine should be an option in myopia control when strict control is needed to lower the risk of progression.